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NEW STUDY: MEDICAID EXPANSIONS REPRESENT BEST WAY TO STOP EROSION OF HEALTH INSURANCE COVERAGE FOR WORKING POOR PARENTS; BUT PRICE TAG IS IN THE BILLIONS

Extending Coverage to Parents Could Help Improve Access to Care for Children – Even Those Already Eligible for SCHIP


Bethesda, MD—Unless states expand Medicaid and the State Children’s Health Insurance Program (SCHIP) to offer coverage to low-income parents it is unlikely that parents living in poverty will gain health insurance coverage. In fact, coverage for the working poor will likely continue to erode, according to a study released today in the March/April issue of the journal Health Affairs.

The authors estimate that extending coverage to parents with incomes below 200 percent of poverty would likely cost in excess of $10 billion per year. But that extension would lead to coverage for 7.4 million, or 70 percent, of the 10.6 million parents who are uninsured, according to the study by Lisa Dubay and Genevieve Kenney of the Urban Institute.

They contend that Medicaid expansions would be far more effective than premium-assistance programs and tax credits at closing the coverage gap for poor parents. And expansions to parents could lead to better access to care for children who are already eligible for SCHIP.

“Uninsured parents living in poverty have little access to employer-sponsored coverage, and even if they did they would have a hard time affording it,” said Dubay. “As it is, more than half have trouble paying utility bills and worry about food shortages.”

Given the current fiscal situations faced by most states, the authors contend that additional dollars from the federal government will likely be necessary. Without those dollars, the coverage situation for parents is likely to deteriorate further and could have a negative impact on low-income parents and their children as well, according to the study.

The numbers of the working poor without health insurance coverage rose from 30 percent in the late 1990s to 34 percent in 2000. In fact, the most recent Current Population Survey data show that a third of all low-income parents lack health insurance coverage.

Extending Coverage to Parents May Improve Access to Care for Children

The study is one of two released today by Health Affairs detailing the health insurance status of working poor parents and their children. The second study, by researchers in California, found that children of the working poor are far more likely to be uninsured than children of nonworking poor families.

In addition, extending coverage to working poor parents could lead to greater access to care for children. According to the authors, extending coverage leads to children who already qualify for SCHIP obtaining more continuous coverage and being seen regularly at a doctor’s office. According to the authors, “public expansions in family insurance coverage are likely to narrow disparities in access to and use of health care for children of the working poor.”

Twenty-one percent of children of the working poor were uninsured in 2000, as were 30 percent of their parents, according to the study conducted by Sylvia Guendelman, professor and chair of the Maternal and Child Health Program in the School of Public Health at the University of California, Berkeley, and Michelle Pearl, research scientist at the Sequoia Foundation.

As would be expected, the study finds that extending insurance coverage such as Medicaid or SCHIP to children markedly increases their access and use of health care services. Children in families with no health insurance coverage at all had a 19 percent higher probability than those with child-only coverage (for example on SCHIP) of delaying or missing care because they could not afford it. They also had a 20 percent higher probability of experiencing unmet health care needs and a 25 percent higher probability of having no regular source of care.

“On almost every indicator that we examined, children with no family coverage encountered more barriers to care than children with child-only or family coverage,” said Guendelman, lead study author. “Most of the benefits of coverage were attributable to child coverage, however extending coverage to the parent may further improve access by reducing breaks in coverage.”

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Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research.

©2004 Project HOPE–The People-to-People Health Foundation, Inc.